Introduction

Advanced or metastatic soft tissue sarcoma (a/mSTS) is associated with a dismal prognosis. Patient counseling on treatment aggressiveness is pivotal to avoid over- or undertreatment. Recently, evaluation of body composition markers like the skeletal muscle index (SMI) became focus of interest in a variety of cancers. This study focuses on the prognostic impact of SMI in a/mSTS, retrospectively.

Methods

181 a/mSTS patients were identified, 89 were eligible due to prespecified criteria for SMI assessment. Baseline CT-Scans were analyzed using an institutional software solution. Sarcopenia defining cut-off values for the SMI were established by optimal fitting method. Primary end point was overall survival (OS) and secondary endpoints were progression free survival (PFS), disease control rate (DCR), overall response rate (ORR). Descriptive statistics as well as Kaplan Meier- and Cox regression analyses were administered.

Results

28/89 a/mSTS patients showed sarcopenia. Sarcopenic patients were significantly older, generally tended to receive less multimodal therapies (62 vs. 57 years, P = 0.025; respectively median 2.5 vs. 4, P = 0.132) and showed a significantly lower median OS (4 months [95%CI 1.9–6.0] vs. 16 months [95%CI 8.8–23.2], Log-rank P = 0.002). Sarcopenia was identified as independent prognostic parameter of impaired OS (HR 2.40 [95%-CI 1.4–4.0], P < 0.001). Moreover, DCR of first palliative medical treatment was superior in non-sarcopenic patients (49.2% vs. 25%, P = 0.032).

Conclusion

This study identifies sarcopenia as a prognostic parameter in a/mSTS. Further on, the data suggest that sarcopenia shows a trend of being associated with first line therapy response. SMI is a promising prognostic parameter, which needs further validation.

中文翻译：

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肌肉减少症对晚期和转移性软组织肉瘤的影响

介绍

晚期或转移性软组织肉瘤 (a/mSTS) 与预后不良有关。就治疗积极性进行患者咨询对于避免过度治疗或治疗不足至关重要。最近，对骨骼肌指数 (SMI) 等身体成分标志物的评估成为各种癌症的关注焦点。本研究回顾性地关注 SMI 在 a/mSTS 中的预后影响。

方法

确定了 181 名 a/mSTS 患者，其中 89 名符合 SMI 评估的预设标准。使用机构软件解决方案分析基线 CT 扫描。通过最佳拟合方法确定定义 SMI 截止值的肌肉减少症。主要终点是总生存期（OS），次要终点是无进展生存期（PFS）、疾病控制率（DCR）、总缓解率（ORR）。进行了描述性统计以及 Kaplan Meier 和 Cox 回归分析。

结果

28/89 a/mSTS 患者出现肌肉减少症。少肌症患者年龄显着增加，通常倾向于接受较少的多模式治疗（62 岁和 57 岁，P  = 0.025；中位数分别为 2.5 和 4，P  = 0.132）并且中位 OS 显着降低（4 个月 [95%CI 1.9 –6.0] 与 16 个月 [95%CI 8.8–23.2]，对数秩P  = 0.002）。肌肉减少症被确定为 OS 受损的独立预后参数（HR 2.40 [95%-CI 1.4–4.0]，P  < 0.001）。此外，首次姑息性药物治疗的 DCR 在非肌肉减少症患者中更优（49.2% vs. 25%，P  = 0.032）。

结论

本研究将肌肉减少症确定为 a/mSTS 中的预后参数。此外，数据表明肌肉减少症显示出与一线治疗反应相关的趋势。SMI 是一个很有前途的预后参数，需要进一步验证。